How can we help this patient after a full year of severe shoulder pain?

This 73-year-old male presents with a one-year history of severe left shoulder pain with decreased range of motion and no history of surgery.

Q1 – He has a tear, but what should we name it?

Q2 – For an advanced question, what is not an uncommon imaging manifestation and clinical sequela for this type of tear?

Q3 – Are there any other notable observations?

Sagittal STIR

Coronal T2


A1 – The name of the tear in this case is posterior rotator interval diastatic (RID) tear. The fibroelastic anterior interval is located between the subscapularis and supraspinatus. The far posterior interval (where we often put our arthrogram needle) is between the teres minor and the infraspinatus. The anterior interval is the space between the subscapularis and supraspinatus, and contains the superior glenohumeral ligament and biceps.

A2 – As for the advanced question, these tears can produce high signal intramuscular and / or sentinel cystic masses due to leakage or diffusion of synovial fluid.

A3 – Another observation you should make is the severe muscular atrophy with fatty infiltration.

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